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Letters
August 23/30, 2006

Birth Spacing and Adverse Perinatal Outcomes—Reply

JAMA. 2006;296(8):929-930. doi:10.1001/jama.296.8.929-b

In Reply: Drs Scheepers and Braat offer the alternative hypothesis that the effects on perinatal outcomes that were observed in our study could be secondary to subfertility of women rather than a consequence of long interpregnancy interval. We do not believe that this explanation is supported by the evidence that they cite. First, the study by Yasmin et al1 included women with multiple pregnancies, which are associated with a higher risk of adverse perinatal outcomes. Moreover, in that study there was no control group, and no potential confounding factors were taken into account. Second, in the study by Thomson et al,2 the majority of subfertile women were primiparous (69%), and there was no information on interpregnancy intervals of those who were multiparous, so that their results were not adjusted for this variable. In addition, 34% of the subfertility cases were attributed to male-factor infertility. Third, the findings of Thomson et al are not supported by the findings of similar studies.3

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